TG-142-报告

TaskGroup142report:Qualityassuranceofmedicalacceleratorsa…EricE.Kleinb
WashingtonUniversity,St.Louis,MissouriJosephHanleyHackensackUniversityMedicalCenter,Hackensack,NewJerseyJohnBayouthUniversityofIowa,IowaCity,IowaFang-FangYinDukeUniversity,Durham,NorthCarolinaWilliamSimonSunNuclearCorp.,Melbourne,FloridaSeanDresserNorthsideHospital,Atlanta,GeorgiaChristopherSeragoMayoClinic,Jacksonville,FloridaFranciscoAguirreM.D.AndersonCancerCenter,Houston,TexasLijunMaUniversityofCalifornia,SanFrancisco,SanFrancisco,CaliforniaBijanArjomandyM.D.AndersonCancerCenter,Houston,TexasChihrayLiuUniversityofFlorida,Gainesville,FloridaConsultants:CarlosSandinElektaOncology,Crawley,UnitedKingdomToddHolmesVarianMedicalSystems,PaloAlto,California
Received24February2009;revised8July2009;acceptedforpublication8July2009;published17August2009Thetaskgroup
TGforqualityassuranceofmedicalacceleratorswasconstitutedbytheAmericanAssociationofPhysicistsinMedicine’sScienceCouncilunderthedirectionoftheRadiationTherapyCommitteeandtheQualityAssuranceandOutcomeImprovementSubcommittee.Thetaskgroup
TG-142hadtwomaincharges.Firsttoupdate,asneeded,recommendationsofTableIIoftheAAPMTG-40reportonqualityassuranceandsecond,toaddrecommendationsforasymmetricjaws,multileafcollimation
MLC,anddynamic/virtualwedges.TheTGaccomplishedtheupdatetoTG-40,specifyingnewtestandtolerances,andhasaddedrecommendationsfornotonlythenewancillarydeliverytechnologiesbutalsoforimagingdevicesthatarepartofthelinearaccelerator.Theimagingdevicesincludex-rayimaging,photonportalimaging,andcone-beamCT.TheTGreportwasdesignedtoaccountforthetypesoftreatmentsdeliveredwiththeparticularmachine.Forexample,machinesthatareusedforradiosurgerytreatmentsorintensity-modulatedradio-therapy
IMRTrequiredifferenttestsand/ortolerances.TherearespecificrecommendationsforMLCqualityassuranceformachinesperformingIMRT.Thereportalsogivesrecommendationsastoactionlevelsforthephysiciststoimplementparticularactions,whethertheyareinspection,scheduledaction,orimmediateandcorrectiveaction.ThereportisgearedtobeflexibleforthephysicisttocustomizetheQAprogramdependingonclinicalutility.Therearespecifictablesaccordingtodaily,monthly,andannualreviews,alongwithuniquetablesforwedgesystems,MLC,andimagingchecks.ThereportalsogivesspecificrecommendationsregardingsetupofaQAprogrambythephysicistinregardstobuildingaQAteam,establishingprocedures,trainingofpersonnel,documentation,andend-to-endsystemchecks.Thetabulateditemsofthisreporthave41974197Med.Phys.36„9…,September20090094-2405/2009/36„9…/4197/16/$25.00©2009Am.Assoc.Phys.Med.beenconsiderablyexpandedascomparedwiththeoriginalTG-40reportandtherecommendedtolerancesaccommodatedifferencesintheintendeduseofthemachinefunctionality
non-IMRT,IMRT,andstereotacticdelivery.©2009AmericanAssociationofPhysicistsinMedicine.DOI:10.1118/1.3190392Keywords:accelerator,QA,qualityassurance,radiotherapyTABLEOFCONTENTSI.INTRODUCTION............................4198I.A.Purpose...............................4198I.B.Background............................4198II.QUALITYASSURANCEOFMEDICALACCELARATORS...........................4199II.A.General...............................4199II.B.Testfrequencies........................4204II.C.Guidelinesfortolerancevalues............4204II.C.1.Acceptancetestingprocedurestandards...4204II.C.2.Commissioningbaselinevalues.........4204II.C.3.Tolerancesandactionlevels............4205II.C.4.Uncertainties,repeatability,andprecision..4205II.D.AncillarytreatmentdevicesnotinTG-40....4206II.D.1.Asymmetricjaws.....................4206II.D.2.Dynamic/virtual/universalwedge........4206II.D.3.MLC...............................4206II.D.4.TBI/TSET...........................4207II.D.5.Radiographicimaging.................4207II.D.6.Respiratorygating....................4208III.SUMMARYOFRECOMMENDATIONS/IMPLEMENTATIONSCHEME...............4209I.INTRODUCTIONI.A.PurposeTheAAPMTG-401reportpublishedin1994isawidelyusedandreferenceddocumentwhichincludesrecommenda-tionsforgeneralqualityassurance
QAtestsformedicallinearaccelerators.SincethepublicationofTG-40,severalnewtechnologieshavebeendevelopedandarenowcom-monlyusedinclinicalpractice.Thesetechnologiesincludemultileafcollimation
MLC,asymmetricjaws,dynamicandvirtualwedges,andelectronicportalimagingdevices
EPIDs.Imageguidancedevicessuchascone-beamCT
CBCT,statickilovoltage
kVimaging,andrespiratorygatingwererarelyusedin1994.Inaddition,TG-40didnotconsiderthedemandsplacedonanacceleratorbyproceduressuchasstereotacticradiosurgery
SRS,stereotacticbodyra-diationtherapy
SBRT,totalbodyphotonirradiation
TBI,andintensity-modulatedradiotherapy
IMRTtreatment.Also,thequalityoflinearacceleratorsintermsofaccuracyandprecisionhasimprovedinrecentyears,allowingforpro-ceduressuchasSRS,SBRT,andIMRT.Thepurposeofthisreportistobuildupontherecommen-dationsofTG-40forQAofmedicallinearacceleratorsin-cludingthebeforementionedtechnologies
MLC,newerwedgesystems,asymmetricjaws,imagingsystems,andres-piratorysystemsandproceduressuchasSRS,SBRT,TBI,andIMRT.Duringthedevelopmentofthisrep